No office rate
Use 53400 for the first stage of the male anterior reconstruction. Use 53405 when the later operation completes that staged repair.
On this page
CMS RVU26D · Effective 2026-10-01
53405 Urethroplasty Medicare reimbursement rates in Kentucky
Reports the second operation in a staged reconstruction of the male anterior urethra, typically tubularizing a healed urethral plate from the first stage. Compare 53405 office and facility rates across CMS payment localities in Kentucky.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 53405 in Kentucky?
Kentucky has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$758.19
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Urologic surgery
About 53405: Second-stage anterior urethral reconstruction
Reports the second operation in a staged reconstruction of the male anterior urethra, typically tubularizing a healed urethral plate from the first stage.
A urologist performs this operation to complete a planned two-stage reconstruction of the male anterior urethra. In the first stage, scarred urethral tissue may be opened and a urethral plate established; after healing, the second-stage operation forms that plate into a urethral channel. This approach may be used for complex anterior urethral strictures or reconstruction after failed hypospadias repair. The procedure is generally performed in an operating room.
Report 53405 when the operative plan and record support the second stage of this male anterior reconstruction, rather than a one-stage repair or the initial stage. Documentation should identify the prior staged procedure, the reconstructed urethral segment, and the work performed to complete the reconstruction. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 53405
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU15.27 · 65%
- Practice expense (office) RVU6.34 · 27%
- Malpractice RVU1.96 · 8%
18
Medicare services in 2024 · #5984 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
53405 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
Both represent a second-stage reconstruction, but 53415 concerns the male posterior urethra; 53405 concerns the male anterior urethra.
No office rate
53425 is the second-stage reconstruction for a different patient anatomy. 53405 is for male anterior urethral reconstruction.
53450
No office rateUrethral revision
53450 describes urethral revision. Choose 53405 when the documented operation is specifically the second stage of a planned male anterior reconstruction.
Compare 53405 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Kentucky →
Office / nonfacility
Unavailable
Facility
$758.19
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 53405 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
6,192
- Code
- 53405
- Physician work
- 15.27
- Practice expense
- 6.34
- Malpractice
- 1.96
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 15.27 | × 1.000 | 15.2700 |
| Practice expense | 6.34 | × 0.889 | 5.6363 |
| Malpractice | 1.96 | × 0.915 | 1.7934 |
| Total RVUs | 22.6997 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$758.19
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 15.27 | 1 |
| Practice expense | 6.34 | 0.889 |
| Malpractice | 1.96 | 0.915 |
(15.27 × 1 + 6.34 × 0.889 + 1.96 × 0.915) × $33.4009 = $758.19
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
53405 billing questions
How is 53405 distinguished from 53400?
53405 is for the second stage of a planned two-stage male anterior urethral reconstruction. 53400 represents the first-stage service.
Can 53405 be reported for a one-stage urethral repair?
No. The record must support completion of a staged reconstruction, not a reconstruction completed in one operation.
Can modifier 50 be used for this procedure?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,18953270,,Removal of urethra gland,A,,3.06,3.10,,1.61,,0.40,6.56,5.07,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19053275,,Repair of urethra defect,A,,4.46,2.06,NA,2.06,,0.62,7.14,7.14,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19153400,,Revise urethra stage 1,A,,13.78,6.06,NA,6.06,,1.83,21.67,21.67,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19253405,,Revise urethra stage 2,A,,15.27,6.34,NA,6.34,,1.96,23.57,23.57,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19353410,,Reconstruction of urethra,A,,17.24,6.87,NA,6.87,,2.22,26.33,26.33,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19453415,,Reconstruction of urethra,A,,20.18,7.49,NA,7.49,,2.61,30.28,30.28,0,090,0.08,0.83,0.09,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,19553420,,Reconstruct urethra stage 1,A,,14.79,5.98,NA,5.98,,1.91,22.68,22.68,0,090,0.08,0.83,0.09,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631